Article 1319

Title of the article

EFFICIENCY AND SAFETY OF THE LONG-TERM THERAPY WITH DIRECT ORAL ANTICOAGULANTS
AT THROMBOEMBOLISM OF THE PULMONARY ARTERY IN REAL CLINICAL PRACTICE 

Authors

Zlobina Dar'ya Sergeevna, Cardiologist, emergency cardiological unit, Nizhny Novgorod Regional Clinical Hospital named after N. A. Semashko (190 Rodionova street, Nizhny Novgorod, Russia); postgraduate student, Privolzhsky Research Medical University (10/1 Minina i Pozharskogo square, Nizhny Novgorod, Russia), E-mail: gashadg@rambler.ru
Koroleva Lyubov' Yur'evna, Doctor of medical sciences, professor, sub-department of hospital therapy named after V. G. Vogralik, Privolzhsky Research Medical University (10/1 Minina i Pozharskogo square, Nizhny Novgorod, Russia), E-mail: klub2004@mail.ru
Kovaleva Galina Valentinovna, Head of emergency cardiological unit, Nizhny Novgorod Regional Clinical Hospital named after N. A. Semashko (190 Rodionova street, Nizhny Novgorod, Russia), E-mail: kogaval@mail.ru
Zlobin Maksim Valer'evich, Rheumatologist, Nizhny Novgorod Regional Clinical Hospital named after N. A. Semashko (190 Rodionova street, Nizhny Novgorod, Russia), E-mail: zlomax@list.ru 

Index UDK

616.12-085.273.53 

DOI

10.21685/2072-3032-2019-3-1 

Abstract

Background. Pulmonary embolism is the third leading cause of cardiovascular mortality. The necessary long-term use of anticoagulants is often accompanied by adverse events: bleeding, recurrence of thrombosis. Purpose of the study is estimate risks of heavy and minor bleeding, recurrence venous thromboembolism (VTE) against the reception of warfarin and direct oral anticoagulants (DOAC) in treatment of pulmonary embolism (PE) for 3, 6, 12 months.
Materials and methods. In the open-label non-randomized prospective study included 79 patients with pulmonary embolism. As anticoagulant therapy, patients of the 1st group received warfarin – 31 patients (39,2 %), the 2nd group – DOAC – 48 patients (60,8 %). All patients underwent ultrasound dopplerography of the veins of the lower extremities, echocardiography, ECG, MSCT-angiopulmonography, as well as the study of laboratory parameters (complete blood count, D-dimers, coagulogram). The efficacy and safety of anticoagulant therapy was assessed in both groups 3, 6, 12 months after the start of treatment using a telephone survey of patients and full-time counseling.
Results. The incidence of bleeding was not statistically different between groups in the period up to 3 months from the start of anticoagulant therapy. With an increase in reception time, the incidence of bleeding increased in patients of the 2nd group (with p < 0,05): after 3–6 months of therapy in 15 patients (31,3 %) and in 6 patients after 6–12 months of taking DOAC (13 %). In the long-term period (6–12 months), there was also a lack of bleeding in the warfarin group and the presence of 6 episodes (13,0 %) in the DOAC group. There were no statistically significant differences between the warfarin and DOAC groups by the number of recurrence of PE. Repeated episodes of pulmonary embolism were detected in the period up to 3 months of treatment (2 (6,4 %) and 1 (2,1 %) cases, respectively), and in periods from 3 to 6 months of therapy (1 (2,1 %) and 4 (8,3 %) cases, respectively). Fatal outcome was more frequently observed in patients receiving warfarin than in patients treated with DOAC (6 and 3 cases, respectively, with p < 0,05).
Conclusion. The lack of laboratory control of anticoagulant efficacy of DOAC presented as an indisputable advantage over vitamin K antagonists. Despite the obvious advantages of modern anticoagulant therapy in the form of fixed dosages, the administration of DOAC also requires dynamic long-term monitoring of patients. 

Key words

pulmonary embolism, anticoagulant therapy, direct oral anticoagulation, warfarin, rivaroxaban, dabigatran, edoxaban 

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Дата создания: 31.10.2019 09:31
Дата обновления: 31.10.2019 10:15